Q: What is the role of HHS in a disaster like last year's Hurricane Katrina?

A: Response in most events, involves three days to 14 days of response activity, although with Katrina, we ended up with response going on for months. When an event occurs in a location, FEMA is the lead dog for federal response. In the health arena, FEMA turns to HHS, which under the national response plan, has the lead role for emergency response.

So FEMA says, 'The state's asking us to provide ambulances, docs and nurses to cover emergency rooms,' or they say there's a number of nursing home patients who have been evacuated to a shelter and they need nurses and pharmacists to provide assistance in a special-needs shelter for these elders and so on and so forth.

(FEMA) turns to us and says 'Here's the mission assignment, here's the funding to support it, you go get it done.' Essentially, we do that with some HHS assets, we do that with some assets from the Veteran's Administration, from (the Department of Defense) and volunteers.

Q: In this health-related response role, what do you feel are HHS's lessons learned if a disaster of roughly the same magnitude were to strike again?

A: First of all, we need to have more identifiable teams of providers who are rostered, trained and equipped to move forward on a rapid basis -- and I'm talking within six to 12 hours -- to be responsive in events of this magnitude.

In fact, we've identified those teams now, we've trained them, we've equipped them and it runs the gamut of a variety of missions. (For example), the National Disaster Medical System, their disaster medical-assistance teams (D-MATs) do a lot of the front-end emergency room work in a pre-hospital environment, and we've mobilized, I think, almost every D-MAT team in the country, which amounts to 65 or 70 teams during the course of a two-to-three-month period there in Louisiana to support and reinforce emergency-room capabilities.

There are also people needed to cover the shelters and we have some 250,000 people displaced internally in Louisiana in various shelter environments that had certain health needs. We had real issues with water and sewage systems, not only in New Orleans, and the five surrounding parishes, but when (the subsequent Hurricane Rita) went through, we had difficulty in five parishes on the other side of the state.

Q: Would these teams be ready to go in rapidly if another Katrina hit?

A: Yeah, indeed. We've exercised them through a number of paper exercises where you have a (simulated) storm, and we challenged them to respond and go through the exercise. But also, Hurricane Chris came through (this year) then stalled out and died, but we stood (the teams) up and we had them prepared to go.

In St. Louis, there were the power outages associated with the flooding and (the teams) stood up for that. St. Louis asked us to provide nurses. The Lebanese repatriation activity in July required medical support, so we stood up teams for that.

Q: Is it fair to say that some of those teams should go back to New Orleans, given that the region is still struggling to get back on its feet a year later?

A: First of all, there's no funding to support them in that mode, because we are dependent on the Stafford Act funding. The Stafford Act has limits on when FEMA can allocate funds to support teams to do this kind of activity, and they've exceeded that limit. That raises questions about the Stafford Act and should it be changed, and so on. But (the law) limits our ability to mobilize manpower, to go down to Louisiana and Mississippi or anywhere else that has manpower shortages.

So we have to go back to our routine authorities, which are not designed with an emergent or urgent environment in mind.

Q: So these teams are designed for the immediate aftermath of a disaster and that's why New Orleans doesn't qualify?

A: Yes, (although with Katrina) we continued to (respond) into February but then FEMA determined that that was the point where they could no longer support emergency teams. And the only exception to that was when they had Mardi Gras. There was a real concern that, with an influx of people during Mardi Gras and the free-flowing booze, etc., there might well be significant emergent demands that would arise, and in fact FEMA funded one of these ... teams to be available during that ten days or so around Mardi Gras.

Q: But since HHS is more specialized with the health issues in a disaster, why can't HHS have its own rapid-response teams to go into a disaster so they're don't have to go through FEMA, and so HHS has the continuing ability to stay engaged until the job is done?

A: Well, because in the national response plans for national disasters and emergencies, the designated leadership resides with the Secretary of Homeland Security. (But) some of that we're thinking about, but I don't think we've worked through an answer on what the best way to approach this is.

I think Secretary (Michael) Leavitt's working very aggressively with the Louisiana Health Collaborative to try to answer some of those questions, based on how the local folks perceive what we do in an emergent basis ...with the idea that we've moving toward a systematic recovery process, and that is a challenging and complex environment.

(The question is), what is the appropriate way to invest in people and facilities that will not only address the shortterm requirements and pressure that are being felt in the community, but will establish a systematic approach ... for the longterm.

Q: So what would you do differently if anther Katrina strikes?

A: I think what we're doing differently is, we're trying to plan in greater detail with the state and local environments to get a better picture of what assets they really have, and what their plans are so that we can identify the potential gaps that we on the federal side, or other states through what are called E-MACs -- emergency medical assistance compacts -- (can) identify for each state a more clear-cut picture ...so that we know if a storm's coming to State X, we can pull up the playbook and its tells us, 'State X is strong here, but weak there and they need federal assistance here, but not there.'

We've developed detailed playbooks in effect, that say, 'If this occurs, then 72 hours before a storm, we do this, the state will do that, the locals will do this.' These are the kinds of improvements that have been undertaken since we went through (Katrina).

Q: How did possible competition and /or tension among agencies contribute to some of the confusion that ensured after Hurricane Katrina?

A: You have to remember that there's always the tension between the locals, the states and the feds, and in the past, that tension would reflect in, 'Well, we don't necessarily want to tell you what we know.' And I think that, incrementally, since (9-11), that has improved, and when you have an event like Katrina, that accelerates the process and the dialogue. But the further away you get from the event, the more people slide back into their usual modes.

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